Endocrine Abstracts

Introduction: Xanthomas are defined as aggregates of lipid-laden histiocytes. They are generally present in superficial soft tissues such as skin and subcutis but can occasionally involve deep soft tissues. Xanthomas are classically associated with hyperlipidemia, that can be primary or secondary to numerous disorders such as diabetes. This case highlights an atypical manifestation of T2D.

Case report: A 61-year-old women was referred to our endocrinology outpatient clinic in July, 2020, due to new-onset diabetes. The patient mentioned weight loss, polyuria, polydipsia and blurred vision for 10 months before diagnosis. Importantly, she mentioned the appearance of several subcutaneous nodules on the buttocks, thighs and forearms 2 months before diagnosis. Her past medical history revealed hypertension controlled with metoprolol. There was no history of alcohol or tobacco use. Laboratory findings showed an elevated fasting blood glucose 444 mg/dl and HbA1c 15.2%, and an altered lipid profile (total cholesterol 249 mg/dl, HDL cholesterol 50 mg/dl, triglycerides 252 mg/dl). Other laboratory findings were unrevealing. On physical examination we outline the presence of multiple firm deep soft tissue masses, with irregular margins and no pain on palpation on the patient’s gluteal region, thighs and forearm. She also had thin yellow to orange plaques on the left lower eyelid compatible with xanthelasma. Subsequent ultrasonography of these lesions revealed multiple hypoechogenic and heterogenous expansive lesions, with undefined borders, they were in touch with aponeurosis but did not infiltrate it, the biggest with the diameter of 56 mm in the gluteal region. The x-ray excluded bone involvement. She started glargine 10U/day with self-adjustment of dosage and metformin 500 mg tid. Three months after introduction of anti-diabetic therapy the masses started to reduce in size and after four months, they had totally disappeared. Biopsy was not performed due to the complete involution of masses. Furthermore, HbA1c decreased to 6% and the lipid profile had improved (total cholesterol 190 mg/dl, HDL cholesterol 58 mg/dl, triglycerides 96 mg/dl).

Discussion: Poor glycemic control has a negative impact on lipid profile. We report a unique case where deep soft tissue masses developed in association with newly diagnosed diabetes with spontaneous resolution after institution of anti-diabetic therapy. The fact that the patient had already a xanthelasma and the complete resolution of the nodules with glycemic and lipid profile improvement favours the diagnosis of deep soft tissue xanthomas.